Keterbukaan sistem puskesmas modal sosial dan kemandirian posyandu

SETYAWATI, Gita Aris, dr. Mubasysyir Hasanbasri, MA

2010 | Tesis | S2 IKM-Kebijakan dan Manajemen Pelayanan Kesehatan

Latar belakang: Peran positif dari pelayanan kesehatan berbasis masyarakat terhadap kesehatan anak telah banyak dilaporkan. Di Indonesia, posyandu merupakan salah satu contoh utama dari model pelayanan ini dan implementasinya berada dibawah pengawasan puskesmas. Program posyandu dilaksanakan oleh kader sukarela dan di beberapa daerah kegiatan ini didanai oleh masyarakat. Namun, penelitian yang menguak tentang latarbelakang yang mendorong kesediaan masyarakat untuk berperan aktif dalam kegiatan posyandu masih sangat terbatas. Tujuan Penelitian: Penelitian ini menggali peran dari sistem terbuka puskesmas dan modal sosial dalam menghasilkan posyandu mandiri. Metode: Penelitian ini menggunakan data Indonesia Family Life Survey gelombang 3. Sistem terbuka diukur dari kunjungan puskesmas ke posyandu, pemberian bantuan, revitalisasi posyandu, dan pelatihan kader. Sedangkan modal sosial diukur dari keanggotaan masyarakat dalam kelompok sosial serta kepercayaan dan hubungan timbal balik. Uji regresi logistik digunakan untuk mengetahui peluang yang terjadi. Hasil: transformasi posyandu yang bersifat mengembangkan kapasitas individu seperti pelatihan kader mampu meningkatkan kemandirian posyandu hingga 4 kali. Keberadaan modal sosial yang tinggi yang ditunjukkan dengan keanggotaan masyarakat dalam kelompok sosial mampu menghasilkan posyandu mandiri hingga 8 kali untuk pedesaan dan 2 kali di perkotaan. Interaksi variabel sistem terbuka dan modal sosial mampu menghasilkan kemandirian posyandu sebesar 11 kali secara signifikan. Kesimpulan: faktor penentu kemandirian posyandu cukup kompleks. Tidak hanya pendekatan sistem puskesmas dalam transformasi posyandu, namun modal sosial juga memiliki potensi dalam pengembangan program-program pelayanan kesehatan berbasis masyarakat seperti posyandu.

Background. The positive role of community based primary health care in improving child health has widely been reported. In Indonesia, Posyandu (post of integrated health service) is the prime example of communitybased primary health care and is under the supervision of health center in sub-district level. Posyandu is undertaken by trained local volunteers and in some area is funded by the community itself. Posyandu has a strategic role in reducing child mortality through both the improvement of nutritional status and the dissemination of health education. Researchers have reported the beneficial effect of Posyandu on communities’ health. However, very little is known about the background shaping the willingness of community to cooperatively sustain service delivery through the Posyandu. Objective. This research examines the role of community social capital in sustaining health service delivery through Posyandu in Indonesia. Method. This research used a cross sectional data of Indonesia Family Life Survey wave 3. Open system was measured by puskesmas visit to posyandu, puskesmas assistance, posyandu revitalization, and cadre training. Social capital was measured by social group with community participation inside and trust-reciprocity. Logistic regression was used to analyze statistical association between the indicators of open system and social capital and self-reliance of posyandu. Result. Implementation of cadre training as part of open system characteristic was significantly associated with posyandu self-reliance with OR 4. The existence of social capital manifestated by social group and participation was significantly associated with posyandu self-reliance with OR value 8 for rural and 2 for urban. Interaction of social capital and open system significantly contributed in resulting posyandu self-reliance. Conclusion. Factors of improving posyandu self-reliance are complex. Not only puskesmas intervene, understanding of social context like social capital should also be considered as an endeavor in developing community-based primary health care like posyandu.

Kata Kunci : Modal sosial,Kelompok sosial dan partisipasi,Sistem terbuka,Kemandirian,Posyandu,Puskesmas,Social capital, social groups and community participation, open system, self-reliance